Abstract
-
Purpose
This study aimed to identify the factors affecting the health promotion behavior of school-aged children informed by the Information-Motivation-Behavioral Skills Model.
-
Methods
A cross-sectional study was conducted with 209 fifth- and sixth-grade elementary school students from Seoul, selected through convenience sampling. Data were collected from March 13 to 31, 2023, using a self-administered questionnaire. The questionnaire included validated tools that measured health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior. Data were analyzed using descriptive statistics, Pearson’s correlation, and stepwise multiple regression, using IBM SPSS/WIN ver. 29.0.
-
Results
The factors influencing the health promotion behavior of school-aged children were social support (β=.43, p<.001), attitude toward health behaviors (β=.27, p<.001), interest in health (high interest group) (β=.14, p=.003), self-efficacy (β=.13, p=.014), and health literacy (β=.10, p=.026). The explanatory power of the model was 63% (F=68.37, p<.001).
-
Conclusion
Based on the results of this study, it is highly recommended to develop and apply health education and health promotion programs that consider health literacy, attitude toward health behaviors, social support, self-efficacy, and interest in health to foster school-aged children’s health promotion behavior.
-
Key words: Child; Health behavior; Health promotion; Information Motivation Behavioral Skills Model
INTRODUCTION
School-aged children are those between the ages of 6 and 12 years; this is the time during which they form healthy lifestyle habits, experience gradual physical growth and development, and achieve psychological stability [
1]. During this period, children develop a systematic understanding of their health and disease, which continues to evolve. However, current statistics show concerning trends such as an overweight rate of 12% and an obesity rate of 18.3% among elementary school students, resulting in a combined overweight and obesity rate of 30.3%, which has increased from the previous year [
2]. Additionally, 29.6% of the first-grade and 51.9% of the fourth-grade elementary school students showed visual impairments. Fortunately, because daily habits are not yet fixed in childhood, acquiring health promotion behaviors is easier at this age than in adulthood, and habits formed during this period seamlessly integrate into and persist throughout adulthood [
3]. Thus, the school-aged years are a critical period for learning and modifying health-related information, attitudes, and behaviors.
Health promotion behaviors play a key role in predicting both current health status and potential risk of future disease development [
4]. Health promotion behaviors are influenced by various factors, including cognitive elements, previous behaviors, and physiological, psychological, and sociocultural factors [
3]. To effectively foster health promotion behaviors, factors such as health-related knowledge, attitudes, values, and beliefs must be considered [
5]. Schools, where children spend a significant amount of time, provide structured environments for the systematic implementation of health education and promotion programs. Therefore, accurately identifying the factors influencing the health promotion behavior of school-aged children is essential for designing effective health education curricula and programs.
Several theories have attempted to explain health promotion behaviors. Among them, the Information-Motivation-Behavioral skills model (IMB model) provides a comprehensive and useful framework, emphasizing three essential determinants: information (specific facts, heuristics, and implicit theories), motivation (personal motivation, such as attitudes toward health behaviors, and social motivation such as social support), and behavioral skills (individual’s objective abilities and self-efficacy) [
6]. Initially developed to explain human immunodeficiency virus-related risk behaviors, the IMB model has since been applied to a wide range of health behaviors, including diabetes self-care and breast self-examination in adults, as well as diabetes self-management, obesity prevention, and fruit and vegetable consumption in children and adolescents [
6-
10]. These applications include both children with chronic conditions and healthy children, demonstrating the IMB model’s broad utility across populations. However, few studies have comprehensively examined overall health promotion behaviors among school-aged children using an IMB model-informed approach, as most previous studies have focused on isolated behaviors. Informed by the IMB model and its application in a previous study [
6,
8], this study selected variables representing each construct—information (health literacy), personal motivation (attitude toward health behaviors), social motivation (social support), behavioral skills (self-efficacy), and health behavior (health promotion behavior)—to identify their combined influence on school-aged children’s health promotion behavior. Based on the prior definition and a child-focused IMB study [
6,
8], behavioral skills were operationalized as self-efficacy in this study. While the original IMB model conceptualizes behavioral skills as a mediator influenced by information and motivation, this study applied a modified approach, guided by a previous child-focused study [
8], in which information, motivation, and behavioral skills were treated as independent input variables influencing health behavior.
Given that the school-aged period is a critical stage for establishing lifelong health habits—particularly as national health education begins systematically in grades 5 and 6, integrating health-related knowledge, values, and skills [
11]—it is essential to identify the key factors influencing health promotion behaviors during this period. Therefore, this study aims to explore the determinants of health promotion behaviors among school-aged children, guided by the IMB model. The findings of this study are expected to provide foundational data for the development of effective and age-appropriate health education and promotion programs.
METHODS
Ethical statements: This study was approved by the Institutional Review Board (IRB) of Sungshin Women’s University (IRB No., SSWUIRB-2023-003). Informed consent was obtained from all participants.
1. Study Design
This cross-sectional study aimed to identify factors influencing health promotion behaviors among school-aged children. The key variables included health literacy, attitude toward health behaviors, social support, and self-efficacy. The reporting of this study followed the guidelines outlined in the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines [
12].
The study targeted fifth- and sixth-grade elementary school students from Seoul, selected through convenience sampling. Sample size was determined using the G*Power ver. 3.1.9.7 program (Heinrich-Heine-Universität Düsseldorf), based on previous studies [
5,
13], with parameters set as follows: effect size (f
2)=0.15, significance level (α)=0.05, power (1–β)=0.95, and 15 predictor variables. This yielded a minimum sample size of 199. A final sample size of 219 was deemed necessary, accounting for a dropout rate of 10%. The selection criteria were as follows: (1) participants were required to possess verbal communication, reading, and writing abilities and no cognitive impairments; and (2) participation was allowed only after both the student and their legal guardian provided informed consent. Initially, 220 questionnaires were distributed. After excluding 11 incomplete responses, the final sample comprised 209 participants.
1) General characteristics
To ascertain the general characteristics of the participants, a self-administered questionnaire was developed comprising nine items based on previous studies [
1,
4,
11,
13-
15].
2) Health literacy
The tool developed by Ahn and Kwon [
16] was adapted and modified to measure health literacy. Permission for use and adaptation was obtained from the original developers. The linguistic health literacy assessment tool by Ahn and Kwon [
16] is based on the 2009 Health Education Curriculum and evaluates seven domains: daily life and health, disease prevention and management, medication misuse and smoking prevention, sexual health, mental health, society and health, and accident prevention and first aid. It consisted of 42 items with six items per domain. Participants responded “yes” if they thought a statement was correct, “no” if incorrect, or “don’t know” if unsure, scoring 1 point for correct answers and 0 points for incorrect or unsure responses. Higher scores indicated greater linguistic health literacy. In the study by Ahn and Kwon [
16], Cronbach’s α was .86.
For this study, the tool was modified to align with the 2015 Revised Health Education Curriculum, focusing on four key domains: understanding health and disease prevention (eight items), making healthy choices in daily life (11 items), safety and first aid (eight items), and health resources and socio-cultural context (three items). The modified tool contained 30 items to maintain the original scoring system. A nursing professor and three school nurses reviewed the revised items to ensure content relevance and appropriateness.
Additionally, functional health literacy was assessed using the tool by Ahn and Kwon [
16], which includes two domains: numerical literacy and reading comprehension literacy. The numerical domain evaluates medication-related skills (six items), scoring 1 point for correct answers. The reading comprehension domain assesses the understanding of snack product labels and children’s news articles (six items). Higher scores indicate greater functional health literacy. In the study by Ahn and Kwon [
16], Cronbach’s α was .68. In this study, linguistic and functional health literacy scores were combined to measure overall health literacy. In this study, Cronbach’s α was .77.
3) Attitude toward health behaviors
Attitude toward health behaviors was measured using the “Intention to Act for Better Health” subscale from the Health Attitude Scale by Torabi et al. [
17], adapted by Kim [
18]. Permission for use was obtained from the original developers. Responses were rated on a 5-point scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Higher scores indicated a more positive attitude toward health behaviors. In the study by Torabi et al. [
17], Cronbach’s α was .88, and in the study by Kim [
18], Cronbach’s α was .84. In this study, Cronbach’s α was .76.
4) Social support
To measure social support, the tool used by Han and Yoo [
19] and further adapted by Ha [
20] for elementary school students was used, with permission from the original developers. The tool by Ha [
20] consists of three domains: support from friends, family, and teachers. Each domain contains eight items, for a total of 24 items. Responses were rated on a 5-point scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Higher scores indicated greater perceived social support. In the study by Ha [
20], Cronbach’s α was .93. In this study, Cronbach’s α was .91.
5) Self-efficacy
The Korean adaptation of the General Self-Efficacy Scale developed by Lee et al. [
21] was used to measure self-efficacy, which is freely available on the website. Responses were rated on a 5-point scale ranging from “not at all true” (1 point) to “exactly true” (5 points). Higher scores indicated greater levels of self-efficacy. In the study Lee et al. [
21], Cronbach’s α was .75. In this study, Cronbach’s α was .87.
6) Health promotion behavior
To measure health promotion behavior, the tool developed by Nah et al. [
22] was adapted and modified, with permission for use and adaptation from the original developers. The tool by Nah et al. [
22], based on the 2009 Health Education Curriculum, originally consisted of 29 items across seven units: daily life and health (five items), disease prevention and management (six items), medication misuse and prevention of smoking and drinking (four items), sexual health (seven items), mental health (two items), society and health (two items), and accident prevention and first aid (three items). Responses were rated on a 5-point scale ranging from “strongly disagree” (1 point) to “strongly agree” (5 points). Higher scores indicate a higher degree of engagement in health promotion behavior. In the study by Nah et al. [
22], Cronbach’s α was .73.
In this study, the tool was modified to align with the 2015 Revised Health Education Curriculum and restructured into four subdomains: understanding health and disease prevention (12 items), making healthy choices in daily life (13 items), safety and first aid (3 items), and health resources and socio-cultural context (1 item), totaling 29 items. The original scoring system was retained. A nursing professor and three school nurses reviewed the revised items to ensure content relevance and appropriateness. In this study, Cronbach’s α was .85.
4. Data Collection & Ethical Considerations
Data were collected from March 13 to 31, 2023. Convenience sampling was employed to recruit the participating schools. School-based research involving school-aged children requires multilevel approval from school principals, legal guardians, and the students themselves, which presents practical limitations for participant recruitment. Therefore, convenience sampling was applied to include schools that voluntarily agreed to participate in the study. The selection criteria were as follows: (1) elementary schools located in Seoul; (2) schools with similar numbers of students and comparable health education curricula and hours; (3) inclusion of both 5th- and 6th-grade students from each school; and (4) voluntary participation ensured through written informed consent from both students and their legal guardians. After convenience sampling, the researcher visited the selected schools and provided preliminary explanations to the principals, school nurses, and homeroom teachers. Two schools agreed to participate in the study. The researcher obtained informed consent from both students and their legal guardians through a two-step process. First, a detailed consent form written in accessible language was distributed to legal guardians, outlining the purpose of the study, its voluntary nature, potential risks and benefits, confidentiality protocols, data solely for research purposes, and procedures for withdrawal at any time without penalty. Second, students capable of providing consent were given a simplified verbal explanation of the study and asked to sign a consent form tailored to their age and comprehension level. The participating students were given a token of appreciation.
5. Data Analysis
The collected data were analyzed using IBM SPSS/WIN ver. 29.0 (IBM Corp.). The general characteristics of the participants were analyzed using frequencies and percentages. Health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior among participants were analyzed using means, standard deviations, and minimum and maximum values. Differences in health promotion behavior according to the participants’ general characteristics were analyzed using an independent t-test and one-way analysis of variance, with post hoc tests conducted using the Scheffé test. Correlations among health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior of participants were examined using Pearson’s correlation coefficients. Stepwise multiple regression analysis was conducted to identify the factors influencing health promotion behavior.
RESULTS
1. Differences in the Degree of Health Promotion Behavior according to the General Characteristics of School-Aged Children
Regarding differences in health promotion behavior according to general characteristics (
Table 1), there were statistically significant differences by grade (t=2.55,
p=.012), subjective health status (F=6.38,
p=.002), academic performance (F=5.92,
p=.003), interest in health (F=12.96,
p<.001), experience with school health education (t=2.85,
p=.005), and subjective family economic status (F=18.84,
p<.001).
The average score of health literacy was 29.35±4.22 points out of 42 points. The average score of attitude toward health behaviors was 19.62±3.36 points out of 25 points. The average score of social support was 97.18±13.02 points out of 120 points. The average score of self-efficacy was 35.87±7.34 points out of 50 points. The average score of health promotion behavior was 113.07±14.09 points out of 145 points (
Table 2).
Health promotion behavior was significantly and positively correlated with social support (
r=.70,
p<.001), attitude toward health behaviors (
r=.62,
p<.001), self-efficacy (
r=.56,
p<.001), and health literacy (
r=.33,
p<.001) (
Table 3).
A stepwise multiple regression analysis was conducted to identify the factors influencing health promotion behavior among school-aged children. The variables included in the analysis were grade, subjective health status, academic performance, interest in health, experience with school health education, and subjective family economic status, which showed statistically significant differences in health promotion behavior among the general characteristics of the participants after being converted into dummy variables. Specifically, for the interest in health variable, two dummy variables were created: “high interest” (coding “very high” and “high” as 1, others as 0) and “low interest” (coding “low” and “very low” as 1, others as 0), with “moderate” interest serving as the reference group. This approach allows for a more nuanced analysis of the impact of different levels of health interest on health promotion behaviors. Health literacy, attitude towards health behaviors, social support, and self-efficacy were set as independent variables and entered into the regression model.
Before conducting the regression analysis, assumptions regarding autocorrelation and multicollinearity were assessed. The Durbin-Watson statistic was 1.69, indicating no evidence of autocorrelation. Visual inspection of the residual scatter plot revealed no systematic pattern, suggesting that the assumptions of independence and homoscedasticity were met. To assess multicollinearity among the independent variables, tolerance values were evaluated, which ranged from 0.612 to 0.893, all well above the commonly accepted threshold of 0.1. The variance inflation factor values ranged from 1.120 to 1.633, all below 10, indicating that multicollinearity was not a concern in the model.
The factors influencing health promotion behavior among school-aged children were health literacy, attitude toward health behaviors, social support, self-efficacy, and interest in health (
Table 4). Social support showed the greatest impact (β=.43,
p<.001). Attitude toward health behaviors (β=.27,
p<.001), interest in health (high interest group) (β=.14,
p=.003), self-efficacy (β=.13,
p=.014), and health literacy (β=.10,
p=.026) were significant predictors of health promotion behavior. The explanatory power of the model was 63% (F=68.37,
p<.001).
DISCUSSION
This study highlights the critical factors to consider when designing health education programs for school-aged children. By identifying significant predictors of health promotion behavior, informed by the IMB model, this study offers practical insights into how theoretical constructs can inform effective strategies in elementary school settings.
Factors affecting health promotion behavior among school-aged children were identified as social support, attitude toward health behaviors, interest in health, self-efficacy, and health literacy. Among the IMB model components, motivational factors such as attitude toward health behaviors and social support emerged as pivotal determinants. These findings support the premise that emotional and interpersonal factors are as critical as cognitive knowledge in shaping children’s engagement in health promotion behaviors.
Social support demonstrated the strongest effect on health promotion behavior, underscoring its foundational role as a motivational construct in the IMB model. This finding aligns with those of previous studies [
1,
13], demonstrating that social support is one of the most influential determinants of health promotion behavior among school-aged children. Students who perceived higher levels of social support exhibited significantly more positive health behaviors [
4]. Moreover, in a previous IMB model-based study, family support emerged as a significant factor influencing diabetes self-management, indicating that social support plays a crucial role in shaping health-related behaviors [
8]. Collectively, these results reinforce the pivotal role of social support as a motivational driver within the IMB framework. As children in this age group rely heavily on relational influences, support from parents, teachers, and peers serves not only as encouragement but also as a behavioral catalyst. This suggests that health programs should include mechanisms that actively engage children’s social networks, such as peer-led health activities, peer mentoring, family-school collaborative programs, and teacher-led motivational reinforcement. For instance, peer-led health clubs can organize health mission projects at the class level, such as weekly step counts or food diaries, while utilizing interactive educational methods such as group discussions. Motivating students through mutual encouragement and competition within teams can foster collaborative health promotion in addition to family camps (e.g., exercise and cooking) where parents and children participate together. Furthermore, fostering a supportive and socially safe environment is equally important. Emotional safety is a precondition for behavioral change, and thus, schools should implement anti-bullying initiatives, mentorship programs, and open-access counseling services.
Attitude toward health behaviors was identified as the second most influential factor affecting health promotion behavior among school-aged children. A more positive attitude was associated with greater engagement in health promotion behavior, which is consistent with previous studies in adults [
18,
23]. However, this contrasts with findings from a study on high school students, in which no significant association was found [
24]. Although few studies have specifically examined the relationship between attitudes and health promotion behavior in school-aged children, this discrepancy may be explained by recent developments in health education. Since 2009, systematic school-based health education programs have been implemented in grades 5 and 6 in Korea, and heightened public awareness due to the COVID-19 (coronavirus disease 2019) pandemic has likely contributed to stronger intentions among children to engage in positive health behaviors. These contextual factors may have strengthened the role of attitude as a motivating force for health-related actions among school-aged children. Further studies are needed to repeatedly examine the influence of attitude toward health behaviors. Attitudes are influenced more by social experiences than by individual personality traits, and evolve through experiences and reinforcement rather than being determined solely by personal characteristics [
17,
25]. Therefore, health education and health promotion programs should not only impart knowledge but also consistently emphasize the value, importance, and necessity of health promotion behaviors. Additionally, health education and programs should include structured reinforcement strategies, such as verbal praise, symbolic rewards, and public recognition, to sustain positive behavioral intentions. Furthermore, the incorporation of emotionally resonant content can foster intrinsic motivation and change long-term attitudes. In this regard, role-playing can be an effective strategy to enhance health attitudes by enabling children to actively experience and reflect on health-related scenarios in a personally meaningful and emotionally engaging way. Collaboration between schools and homes, where teachers and parents demonstrate desirable health behaviors as role models, can help children develop positive attitudes.
Interest in health (high interest group) was a significant factor influencing health promotion behavior. In this study, students who responded “high” or “very high” to the interest in health item demonstrated significantly better health promotion behavior compared to those with moderate interest. Previous studies have indicated a statistically significant difference between interest in health and health promotion behavior [
13]. However, few studies have indicated it as a significant factor affecting health promotion behavior, which contrasts with the findings of this study. Notably, interest in health is not an original component of the IMB model; however, this study identified it as a unique and significant predictor of health promotion behavior in school-aged children. This finding suggests that children’s interest in health is closely linked to their actual health promotion behaviors. By identifying interest in health as an independent factor, this study expands upon the IMB model framework and indicates that, beyond information, motivation, and behavioral skills, personal interest may serve as an additional facilitator of health promotion behavior. Future studies should continue to investigate the impact of interest in health. Nevertheless, given that this study identified a significant association between interest in health and health promotion behavior among school-aged children, fostering their interest in health could serve as a key motivational factor for maintaining or improving a healthy lifestyle. Therefore, student-centered activities, such as games, simulations, and other diverse educational methods, should be aligned with children’s interests and cognitive developmental stages. In particular, gamification-based education has been shown to promote learning, motivation, and problem solving through competition, cooperation, and active participation, and has demonstrated effectiveness in health management, such as oral health [
26]. Accordingly, the use of health-themed games in health education should be considered a strategy to enhance students’ engagement and sustained interest.
Self-efficacy emerged as a factor that positively influenced health promotion behavior. This finding is consistent with numerous previous studies that have reported self-efficacy as a major factor in enhancing health promotion behavior [
1,
4,
13]. In a study informed by the IMB model, self-efficacy was the most significant factor influencing diabetes self-management, indicating that self-efficacy plays a crucial role in shaping health-related behaviors [
8]. Higher self-efficacy has consistently been associated with greater engagement in health promotion behaviors. Self-efficacy is one of the strongest predictors of health promotion behavior [
3] and a core behavioral skill in the IMB framework, significantly influencing health promotion behavior [
6]. Unlike short-term group education sessions, sustainable behavioral change requires a process in which children independently set goals, monitor their progress, and evaluate outcomes. Particularly, mobile health applications represent a valuable tool for supporting the health and well-being of children [
27] and offer a promising strategy for enhancing self-efficacy. Applications that incorporate features such as badges for completing daily hydration or weekly step count challenges can reinforce goal setting, provide real-time progress tracking, and deliver motivational feedback. Therefore, school health education programs should be designed to actively foster self-efficacy through age-appropriate engagement strategies. For example, incorporating digital tools, such as activity tracking apps or interactive behavior contracts, into health classes can help children practice autonomous health management. In-class activities should also guide students through goal setting, self-monitoring, and reflection processes, thereby empowering them to take ownership of their health behaviors both within and beyond the classroom.
Finally, health literacy was positively associated with health promotion behavior and emerged as a significant predictor. This finding is consistent with previous studies on late school-aged children [
11] and middle school students [
14], which found that linguistic health literacy was a key factor influencing health promotion behavior. Health literacy is recognized as a key determinant of health in both the United States’ “Healthy People 2030” and South Korea’s “Health Plan 2030,” and its significance is acknowledged as a critical strategy for health promotion. Low health literacy tends to lead to more negative health behaviors such as smoking or drinking [
28]. In contrast, individuals with higher health literacy exhibit higher rates of disease prevention and healthy behavior practices [
29]. The United States has developed the National Health Education Standards, which focus on enhancing students’ health literacy, thereby laying the groundwork for health education curricula. In alignment with this approach, incorporating health literacy skills into the health education curriculum is important for improving students’ ability to access, understand, and apply health information effectively. Health literacy refers to the ability to recognize health-related issues and make informed decisions by acquiring, understanding, and utilizing the health information and services necessary for maintaining well-being [
30]. To enhance health literacy, it may be beneficial to design simulation-based educational programs that involve identifying relevant information for simulated scenarios, evaluating the appropriateness of the information, and effectively applying it within the context of the simulation. Furthermore, considering the recent trends highlighting the use of digital devices and emphasizing digital literacy, methods, and technologies that can enhance health literacy and apply e-health literacy should be included in health education.
CONCLUSION
This study, informed by the IMB skills model, identified key factors influencing health promotion behavior among school-aged children. Health literacy, attitude toward health behaviors, social support, self-efficacy, and interest in health were all found to significantly impact health promotion behavior. Of these, social support emerged as the most influential factor. These findings underscore the importance of developing and implementing school-based health education and promotion programs that address not only cognitive knowledge but also motivational and behavioral skills tailored to the developmental characteristics of school-aged children.
Several recommendations are made based on the findings of this study. First, because this study used a convenience sample of fifth- and sixth-grade students from two elementary schools in a single city, caution is warranted when generalizing the results. Future studies should include a more diverse sample of school-aged children from various regions and school settings to enhance the generalizability of the findings. Second, although this study applied a modified IMB model, it may not fully capture the complex and dynamic interrelationships among the variables. Future studies should employ advanced analytical methods, such as structural equation modeling, to explore potential mediating and moderating effects and elucidate causal pathways. Finally, intervention studies are needed to design, implement, and evaluate school health education and promotion programs grounded in the IMB model to promote sustainable health behaviors among school-aged children and improve long-term health outcomes.
ARTICLE INFORMATION
Table 1.Differences in the degree of health promotion behavior according to the general characteristics of school-aged children (N=209)
|
Characteristic |
No. (%) |
Health promotion behavior |
|
Mean±SD |
t / F (p) |
Post hoc test |
|
Gender |
|
|
–1.17 (.244) |
|
|
Male |
104 (49.8) |
111.92±13.97 |
|
|
|
Female |
105 (50.2) |
114.20±14.18 |
|
|
|
Grade |
|
|
2.55 (.012) |
|
|
5th |
77 (36.8) |
116.27±14.23 |
|
|
|
6th |
132 (63.2) |
111.20±13.71 |
|
|
|
Subjective health status |
|
|
6.38 (.002) |
a>b,ca)
|
|
Healthya
|
146 (69.9) |
115.22±11.40 |
|
|
|
Normalb
|
49 (23.4) |
108.94±14.74 |
|
|
|
Unhealthyc
|
14 (6.7) |
105.07±13.57 |
|
|
|
Academic performance |
|
|
5.92 (.003) |
a>b,cb)
|
|
Higha
|
109 (52.2) |
115.76±14.42 |
|
|
|
Middleb
|
93 (44.5) |
110.80±12.93 |
|
|
|
Lowc
|
7 (3.3) |
101.29±14.12 |
|
|
|
Experience with hospitalization |
|
|
–.73 (.470) |
|
|
No |
120 (57.4) |
112.46±14.16 |
|
|
|
Yes |
89 (42.6) |
113.89±14.02 |
|
|
|
Source of health information (multiple response) |
|
|
1.80 (.112) |
|
|
Broadcasting media (TV, radio, etc.) |
49 (23.4) |
114.53±14.39 |
|
|
|
Internet, SNS, applications, etc. |
62 (29.7) |
110.24±12.98 |
|
|
|
Print media (book, newspaper, magazine, etc.) |
19 (9.1) |
116.58±14.35 |
|
|
|
Friend or family |
65 (31.1) |
114.77±16.11 |
|
|
|
School class or teacher |
35 (16.7) |
110.60±12.63 |
|
|
|
Health care provider (doctor, nurse, chemist, etc.) |
44 (21.1) |
116.95±13.47 |
|
|
|
Interest in health |
|
|
12.96 (<.001) |
a>b,c,d,ec); b>cd)
|
|
Very higha
|
29 (13.9) |
125.86±11.17 |
|
|
|
Highb
|
70 (33.5) |
115.99±11.50 |
|
|
|
Moderatec
|
84 (40.2) |
107.93±13.27 |
|
|
|
Lowd
|
16 (7.7) |
107.94±11.56 |
|
|
|
Very lowe
|
10 (4.8) |
106.90±20.19 |
|
|
|
Experience with school health education |
|
|
2.85 (.005) |
|
|
No |
111 (53.1) |
115.63±13.09 |
|
|
|
Yes |
98 (46.9) |
110.16±14.67 |
|
|
|
Subjective family economic status |
|
|
18.84 (<.001) |
a>b,ce)
|
|
Higha
|
68 (32.5) |
120.85±12.10 |
|
|
|
Middleb
|
129 (61.7) |
109.74±13.27 |
|
|
|
Lowc
|
12 (5.7) |
104.75±15.18 |
|
|
Table 2.Health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior of school-aged children (N=209)
|
Variable |
Mean±SD |
Min–max |
|
Health literacy |
29.35±4.22 |
18–39 |
|
Attitude toward health behaviors |
19.62±3.36 |
10–25 |
|
Social support |
97.18±13.02 |
63–120 |
|
Self-efficacy |
35.87±7.34 |
16–50 |
|
Health promotion behavior |
113.07±14.09 |
73–141 |
Table 3.Correlations among health literacy, attitude toward health behaviors, social support, self-efficacy, and health promotion behavior in school-aged children (N=209)
|
Variable |
r (p) |
|
1 |
2 |
3 |
4 |
5 |
|
1. Health literacy |
1 |
|
|
|
|
|
2. Attitude toward health behaviors |
.30 (<.001) |
1 |
|
|
|
|
3. Social support |
.23 (.001) |
.51 (<.001) |
1 |
|
|
|
4. Self-efficacy |
.18 (.008) |
.48 (<.001) |
.55 (<.001) |
1 |
|
|
5. Health promotion behavior |
.33 (<.001) |
.62 (<.001) |
.70 (<.001) |
.56 (<.001) |
1 |
Table 4.Factors affecting health promotion behavior of school-aged children (N=209)
|
Variable |
B |
SE |
β |
t |
p
|
|
(Constant) |
25.11 |
5.78 |
|
4.35 |
<.001 |
|
Social support |
.46 |
.06 |
.43 |
7.80 |
<.001 |
|
Attitude toward health behaviors |
1.12 |
.22 |
.27 |
5.02 |
<.001 |
|
Interest in health (high interest group) |
3.97 |
1.30 |
.14 |
3.05 |
.003 |
|
Self-efficacy |
.26 |
.10 |
.13 |
2.47 |
.014 |
|
Health literacy |
.34 |
.15 |
.10 |
2.24 |
.026 |
REFERENCES
- 1. Kim HS, Kim YI. Factors related to health promoting behavior in late school-age children. J Korean Soc Sch Health [Internet]. 2010 [cited 2025 Feb 12];23(1):1-10. Available from:
https://koreascience.kr/article/JAKO201008753771566.page
- 2. Korea Disease Control and Prevention Agency. 2023 School Health Examination Survey [Internet]. Korea Disease Control and Prevention Agency; 2024 [cited 2025 Feb 12]. Available from: https://www.kdca.go.kr/board/board.es?mid=a20501000000&bid=0015&list_no=724898&cg_code=&act=view&nPage=1&newsField=202403
- 3. Pender NJ, Murdaugh CL, Parsons MA. Health promotion in nursing practice. 5th ed. Pearson Prentice Hall; 2006.
- 4. Kim SH, Lee JH. Test of a hypothetical model for health promoting behavior in school-aged children. Child Health Nurs Res [Internet]. 2008 [cited 2025 Feb 12];14(1):22-34. Available from: https://koreascience.kr/article/JAKO200815750719015.page
- 5. Jeon GE, Kwon IS. Factors affecting health promotion behaviors of upper grade elementary students. Child Health Nurs Res. 2017;23(3):319-328. https://doi.org/10.4094/chnr.2017.23.3.319
- 6. Fisher WA, Fisher JD, Harman J. The information-motivation-behavioral skills model: a general social psychological approach to understanding and promoting health behavior In: Rook DW, editors. Social psychological foundations of health and illness. Blackwell Publishing; 2003. p. 82-106. https://doi.org/10.1002/9780470753552.ch4
- 7. Chang SJ, Choi S, Kim SA, Song M. Intervention strategies based on information-motivation-behavioral skills model for health behavior change: a systematic review. Asian Nurs Res. 2014;8(3):172-181. https://doi.org/10.1016/j.anr.2014.08.002
- 8. Lee H, Choi EK, Kim H, Kim HS, Kim HS. Factors affecting the self-management of adolescents with type 1 diabetes mellitus based on the information-motivation-behavioral skills model. Child Health Nurs Res. 2019;5(2):234-243. https://doi.org/10.4094/chnr.2019.25.2.234
- 9. Bartholmae MM. The information-motivation-behavioral skills model: an examination of obesity prevention behavioral change in children who participated in the afterschool program Virginia Beach Let’s Move [dissertation]. Norfolk (VA): Old Dominion University; 2016. https://doi.org/10.25777/xv08-0b09
- 10. Fleary SA, Joseph P, Chang H. Applying the information-motivation-behavioral skills model to explain adolescents’ fruits and vegetables consumption. Appetite. 2020;147:104546. https://doi.org/10.1016/j.appet.2019.104546
- 11. Jang BS, Kim DH. Health literacy and health behavior in late school-age children. J Korean Acad Commun Health Nurs. 2015;26(3):199-208. https://doi.org/10.12799/jkachn.2015.26.3.199
- 12. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-808. https://doi.org/10.1136/bmj.39335.541782.AD
- 13. Park SH, Kim KS. Factors affecting health promotion behaviors of elementary students: for children who use community child care centers. J Korea Ent Ind Assoc. 2022;16(2):131-142. https://doi.org/10.21184/jkeia.2022.2.16.2.131
- 14. Jeong AY. Influence of health literacy on health promotion behavior in middle school students [dissertation]. Wanju: Woosuk University; 2017.
- 15. Ko H, Kim S. A study on the factors influencing health information literacy of adolescent. J Korean Biblia Soc Lib Inf Sci. 2020;31(1):357-377. https://doi.org/10.14699/kbiblia.2020.31.1.357
- 16. Ahn EJ, Kwon IS. Health literacy of elementary school students. Child Health Nurs Res. 2014;20(4):322-331. https://doi.org/10.4094/chnr.2014.20.4.322
- 17. Torabi MR, Seo DC, Jeng I. Alternate forms of health attitude scale. Am J Health Behav. 2004;28(2):166-172. https://doi.org/10.5993/ajhb.28.2.7
- 18. Kim H. The effects of individual-family-environmental factors on the physical health behaviors of people with mental illness: based on the theory of triadic influence. Ment Health Soc Work. 2019;47(2):127-163. http://doi.org/10.24301/MHSW.2019.06.47.2.127
- 19. Han MH, Yoo AJ. The relation of stress and perceived social support to problem behavior. Korean J Child Stud [Internet]. 1996 [cited 2025 Feb 12];17(1):173-188. Available from: https://koreascience.kr/article/JAKO199626661729749.page
- 20. Ha HS. The moderating effect of social support on the relationship between elementary school students’ self-esteem and subjective well-being [dissertation]. Suwon: Ajou University; 2015.
- 21. Lee YM, Schwarzer R, Jerusalem M. Korean Adaptation of the General Self-Efficacy Scale [Internet]. Freie Universität Berlin; 1994 [cited 2025 Feb 12]. Available from: http://userpage.fu-berlin.de/~health/korean.htm
- 22. Nah JY, Kim YI, Kim HS. The effects of systematic health education on health knowledge and health promotion behavior in elementary school students. J Korean Soc Sch Health. 2011;24(2):173-180. https://doi.org/10.15434/kssh.2011.24.2.4
- 23. Park S, Lee YH. Effects of perceived health status, health attitude, and health concern on health promoting behavior in adults. J Korea Contents Assoc. 2016;16(12):192-202. https://doi.org/10.5392/JKCA.2016.16.12.192
- 24. Noh HI, Kim M. A comparative study on the relationship between health knowledge to health attitude and health practical health behaviors among high school students in Seoul. Korean J Health Educ Promot [Internet]. 2004 [cited 2025 Feb 12];21(1):115-135. Available from: https://koreascience.kr/article/JAKO200411922616506.page
- 25. Kim HW. The effect of the topic-centered reading activity on the attitudes towards the handicapped. J Read Res [Internet]. 2003 [cited 2025 Feb 12];9:89-116. Available from: https://m.riss.kr/search/detail/DetailView.do?p_mat_type=1a0202e37d52c72d&control_no=0e5e11150dbe847b47de9c1710b0298d
- 26. Moreira R, Silveira A, Sequeira T, Durão N, Lourenço J, Cascais I, et al. Gamification and oral health in children and adolescents: scoping review. Interact J Med Res. 2024;13:e35132. https://doi.org/10.2196/35132
- 27. Lee J, Su Z, Chen Y. Mobile apps for children’s health and wellbeing: design features and future opportunities. AMIA Annu Symp Proc. 2024;2023:1027-1036.
- 28. DeWalt DA, Hink A. Health literacy and child health outcomes: a systematic review of the literature. Pediatrics. 2009;124 Suppl 3:S265-S274. https://doi.org/10.1542/peds.2009-1162B
- 29. Scott TL, Gazmararian JA, Williams MV, Baker DW. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002;40(5):395-404. https://doi.org/10.1097/00005650-200205000-00005
- 30. Institute of Medicine (US). Health literacy: a prescription to end confusion. National Academies Press; 2004.
